Healthcare Provider Details

I. General information

NPI: 1952714982
Provider Name (Legal Business Name): MAGED GHALY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2014
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5429 HOLLYWOOD BLVD
LOS ANGELES CA
90027-3405
US

IV. Provider business mailing address

5429 HOLLYWOOD BLVD
LOS ANGELES CA
90027-3405
US

V. Phone/Fax

Practice location:
  • Phone: 323-957-6830
  • Fax: 323-962-3211
Mailing address:
  • Phone: 323-957-6830
  • Fax: 323-962-3211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number66507
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: